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Performances of disseminated intravascular coagulation scoring systems in septic shock patients
Julie Helms1,2, François Severac3,4, Hamid Merdji1,5
1Hôpitaux Universitaires de Strasbourg, Service de Médecine Intensive Réanimation, Nouvel Hôpital Civil, 1, Place de l'Hôpital, 67091, Strasbourg Cedex, France.
Insights
The JAAM-DIC and ISTH overt-DIC scores are effective for diagnosing disseminated intravascular coagulation (DIC) in septic shock patients. The sepsis-induced coagulopathy (SIC) score offers limited added value, whether used alone or combined with other scoring systems.
Area of Science:
- Critical Care Medicine
- Hematology
- Infectious Diseases
Background:
- Diagnosing septic shock-induced disseminated intravascular coagulation (DIC) lacks a definitive gold standard.
- Multicenter prospective studies are crucial for evaluating diagnostic and prognostic tools.
Purpose of the Study:
- To assess the performance of major scoring systems for mortality prediction and DIC diagnosis in septic shock.
- To compare the efficacy of JAAM-DIC 2016, ISTH overt-DIC 2001, and Sepsis-Induced Coagulopathy (SIC) scores.
Main Methods:
- Prospective, multicenter study involving 582 patients admitted to the ICU for septic shock.
- Evaluation of JAAM-DIC 2016, ISTH overt-DIC 2001, and SIC scores at ICU admission (day 1) and day 2.
- Analysis of diagnostic accuracy, mortality prediction, and concordance between scoring systems.
Main Results:
- A moderate concordance was observed between ISTH overt-DIC and JAAM-DIC scores (κ=0.67).
- The SIC score showed high sensitivity (0.95) but low specificity (0.18) for mortality prediction.
- JAAM-DIC and ISTH overt-DIC scores demonstrated better specificity for mortality prediction (0.71 and 0.76, respectively) with no significant difference in early DIC detection timing.
Conclusions:
- The added value of the SIC score alone or in combination with other scores is limited in septic shock patients.
- Both JAAM-DIC and ISTH overt-DIC scores are viable options for diagnosing DIC in septic shock.
- Further research may refine diagnostic criteria for septic shock-induced DIC.
Background:
There is no gold standard to diagnose septic shock-induced disseminated intravascular coagulation (DIC). The objective of our multicenter prospective study was to assess the performances of the different major scoring systems in terms of mortality prediction and DIC diagnosis. The JAAM-DIC 2016 score, the ISTH overt-DIC 2001 score, the associations of sepsis-induced coagulopathy (SIC) score with JAAM-DIC 2016 or ISTH overt-DIC scores were tested in patients within 12 h of their admission in ICU for septic shock (day 1) and at day 2.
Results:
582 patients were enrolled in the study. 182/567 (32.1%) were diagnosed with DIC according to ISTH overt-DIC score, and 193/561 (34.4%) according to JAAM-DIC score; 486/577 patients (84.2%) were diagnosed with a coagulopathy according to SIC score. A moderate concordance was observed between ISTH overt-DIC and JAAM-DIC [κ = 0.67 (0.60, 0.73), p < 0.001]. The delay of positivity of the scores for early DIC patients was not different between JAAM-DIC and ISTH overt-DIC scores. Although it was positive earlier, SIC score had worse diagnosis specificity, as 84.2% of the patients with septic shock were diagnosed with "coagulopathy". The specificity of SIC score alone to predict mortality was very low [0.18 (0.15; 0.22)], compared to the ones of JAAM-DIC score [0.71 (0.67; 0.75)], and of ISTH overt-DIC score [0.76 (0.72; 0.80)], p < 0.001. The sensitivity of SIC score to predict mortality was 0.95 [0.89; 0.98], and the ones of JAAM-DIC score and ISTH overt-DIC score were 0.61 [0.50; 0.70] and 0.68 [0.58; 0.77], respectively. There was no benefit in sensitivity and specificity in combining SIC score to JAAM-DIC score or to ISTH overt-DIC score, compared to JAAM-DIC score or ISTH overt-DIC score alone.
Conclusions:
Our data suggest that the added value of SIC score alone or combined with other scores is limited, and that both JAAM-DIC score and ISTH overt-DIC score can be used in septic shock patients. Trial registration clinicaltrial; Trial registration number: NCT02391792; Date of registration: 18/03/2015; URL of trial registry record: https://clinicaltrials.gov/ct2/show/NCT02391792?term=meziani&draw=4&rank=1.
